HomeMy WebLinkAboutHomestead_Wilson (3)H. PREPARER
Preparer of the Sales Disclosure Form
Title
Milton Norman
Settlement Agent
Company
Email Address
Telephone Number
Hometown Title LLC
orders@hometowntitles.com
( 812 ) 461-6399
Address (number and street, city, state, country, and ZIP Code)
25 NW Riverside Drive, Suite 310, Evansville, IN 47708
I. SELLER(S)/GRANTOR(S)
Seller 1 -Nam as it appears on conveyance document
Seller 2 - Name as appears on conveyance document
Kimberly M. Hermann
(number and street)
Address (number and street)
FAddress
1 E Clark St
ity, State, and ZIP Code
City, State, and ZIP Code
Owensville, IN 47665
^;
Of
Country
Country
US
Email Address
Telephone Number
Email Address `gJ� hone Number
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Under penalties of perjury, I hereby certify this Sales Disclosure, to the best of my knowledge belief, is true, correct, and complete as
required by lay, and is prepared in accordance with IC 6-1.1-5.5. A person who knowingly a y�alsifie the value of transferred
GGSelle
omits or falsifies any information required to be provided, commits a LevelV
Signature of Seller
Mproperty/or
of Seller
Date i ed (m /dd/ yyy)
Printed Name of Seller
Date Signed (mm/dd/yyyy)
Hermann
(S)IGRANTEE(S) — APPLICAT ON FOR PROPERTY TAX DEDUCTIONS - IDENTIFY ALL THAT APPLY
Buyer 1 - Name as it appears on conveyance document
Buyer 2 - Name as it appears on conveyance document
Kelly Wilson
Darren Wilson
Address umber n street)
Address (number and street)
City, State, and ZIP Code �( ; /
City, State, and Zl Co'
A/
V 7ti
tCountry
Country
US
Email Address
Telephone Number
Email Address
Telephone Number
Pursuant to IC 6-1.1-12-44, the Sales Disclosure Form maybe used to apply for certain deductions. Identify all of those that apply:
YES NO CONDITION
YES NO CONDITION
1. Will this property be the buyer's primary
® O 3. Homestead
® residence?
Q A 4. Solar Energy Heating or Cooling System
D ® 5. Wind Power Device
2. Does the buyer have a homestead to be vacated
for this residence? If yes, provide address:
O ® 6. Hydroelectric Power Device
O ® 7. Geothermal Energy Heating or Cooling Device
Address (number and street)
City, State, and ZIP Code County
Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct, and complete
as required by law, and is prepared In accordance with IC 6-1.1-5.6. A person who knowingly and intentionally falsifies the value of
transferred real property, or omits or falsifies any information required to be provided, commits a Level 5 felony. (Note: Both spouse's
information, SSN(Driver's License(/0/Other Number is necessary only if a Homestead Deduction is being filed.)
Signature of Buyer
Signatur u er 2/Spouse
Printed Legal Name o uy r 1 Sign Dat (M /DD )
Printe Legal Name of Buyer 2/Spouse Sign pat (MMI D )
Kelly Wilsoni ai' �-�
Darren Wilson
Last 5 Digits of Buyer 1 SSN/Driver's License/ID/Other Nu ber
Last 5 Digits of Buyer 2/Spouse SSN/Driver's LicenseA(D/Oth& Number
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